Does S8040 require prior authorization?

No, S8040 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for S8040?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S8040`, Topographic brain mapping

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Document rationale and baseline measures if pursuing complementary or investigational therapies (neurofeedback, dietary interventions, supplementation) and obtain informed consent discussing limited evidence and uncertainties.
When pharmacologic therapy is used, document medication trials, doses, response and adverse effects where relevant (discussion of stimulants, atomoxetine, bupropion, TCAs appears in the evidence review).

EndeavorRx: requirement implied in indication — documentation of patient age (8 to 12 years), ADHD subtype (primarily inattentive or combined-type), and a "demonstrated attention issue" measurable by computer-based testing (e.g., baseline computer-based attention testing).

AKL-T01 (as studied): documentation used in trials included psychiatric screening, ADHD ratings, baseline neuropsychological measures, and objective attentional performance measures such as the TOVA Attention Performance Index (API) with trial inclusion requiring TOVA API ≤ -1.8.

Extended-release methylphenidate (clinical use): documentation of adult ADHD diagnosis (trials enrolled adults diagnosed with ADHD); note that many trials excluded psychiatric co-morbidity so documentation of comorbid conditions and prior medication responses may affect applicability.

WAVi / qEEG: clinicians should document that a standard clinical evaluation was performed and that EEG/qEEG is not being used to "confirm" a diagnosis; if EEG/qEEG is performed it should be documented as part of a research protocol or as adjunctive information with explicit informed discussion of limitations and risk of misdiagnosis.

Key Coverage Criteria

"EndeavorRx is a digital therapeutic (video game-based) indicated to improve attention function as measured by computer-based testing in children aged 8 to 12 years with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue."
EndeavorRx: "should be considered for use as part of a therapeutic program that may include clinician-directed therapy, medication, and/or educational programs, which further address symptoms of the disorder."
AKL-T01 (investigational digital therapeutic): indicated in study context to target attention and cognitive control in pediatric patients with ADHD (studied in children aged 8 to 12 years in STARS-ADHD RCT and aged 8 to 14 in adjunct study STARS-Adjunct).
AKL-T01 (study-specified objective inclusion): pediatric patients with confirmed ADHD and TOVA Attention Performance Index (API) scores of -1.8 and below (STARS-ADHD trial).
Extended-release methylphenidate: discussed as the "recommended 1st-line pharmacological treatment" for adults with ADHD (Cochrane review examined extended-release formulations in adults diagnosed with ADHD).
Tryptophan modulation: investigated in clinical trials for effects on ADHD-related symptoms (evidence insufficient; trials mainly used acute tryptophan depletion procedures).

8 Active Policies

ANTHEM-MED.00002, Selected Sleep Testing Services

AETNA-CPB-0426, Attention Deficit/Hyperactivity Disorder

AETNA-CPB-0221, Quantitative EEG (Brain Mapping)

AMBETTER-CP.BH.124, Attention Deficit Hyperactivity Disorder Assessment and Treatment

BCBSIL-MED205.040, Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder, Cognitive Impairment, or Autism Spectrum Disorder

BCBSMT-MED205.040, Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder, Cognitive Impairment, or Autism Spectrum Disorder

BCBSNM-MED205.040, Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder, Cognitive Impairment, or Autism Spectrum Disorder

BCBSOK-MED205.040, Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder, Cognitive Impairment, or Autism Spectrum Disorder

`S8040`, Topographic brain mapping

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

S8040, Topographic brain mapping

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`S8040`, Topographic brain mapping